Making Margin with the Medical Home

Kristen K. Brown, MD, at Westshore Family Medicine, a Mercy Health Partner–owned group practice in Muskegon, MI, says her practice is finding a way to make the medical home work financially now. A family physician, Brown and the other eight physicians in the practice started changing how the practice operated back in 2000 with the addition of an EMR—technology Brown says is essential to the success of a medical home.

“We felt like we were drowning in paperwork,” she says. “We added McKesson’s Practice Partner Patient Record EMR and then we started looking for ways to improve our processes and our quality. We wanted to create a better design for our workflow and we wanted to make our office more of a team.”

The team approach translated through many of the practice’s processes. For instance, rather than a physician needing to approve patient medication refill requests or an individual nurse addressing all the refill requests, the practice created a set of protocols to allow other members of the team to handle the requests. Making process improvements spurred the practice to look at the care model being used, too.

Having put the EMR in place early on, the physicians and staff were all comfortable with it when another opportunity arose in 2006—the chance to participate in a national medical home pilot through TransforMED, a Leawood, KS–based wholly-owned subsidiary of the American Academy of Family Physicians that works to help medical practices implement this new care model. Westshore Family Medicine was one of 36 group practices nationwide chosen to participate in the initial two-year study.

“Over the last 50 years, our technology and medicine has changed a great deal, but the exam room hasn’t. We are looking at that in our medical home,” explains Brown. “So we started by looking at every area where the patient touched someone on our team. Then we aligned the team so each member could work to the fullest extent of their licensure. We created ‘teamlets’ consisting of two medical assistants and a physician. Then we started looking at which patients we needed to reach most.”